Eliminating Hepatitis B in the United States—Mothers Matter!

Corinna DanEvery year, 25,000 women with chronic hepatitis B infection give birth, according to the Centers for Disease Control and Prevention (CDC). They are a subset of the estimated 700,000 to 1.4 million people chronically infected with hepatitis B virus in the U.S., but merit our special attention because of the risk of perinatal hepatitis B infection, which occurs when the virus is transmitted from a mother to her infant. Although such transmission is completely preventable, an estimated 952 infants in the U.S. were infected perinatally in 2009, the most recent year for which estimates are available.

Given the relatively small, yet stubbornly persistent number of perinatal hepatitis B infections in the U.S., the national Viral Hepatitis Action Plan (Action Plan) set as one of its overarching goals the elimination of perinatal hepatitis B transmission in the U.S. by 2020. The steady annual number of perinatal hepatitis B cases is particularly concerning because approximately 90% of HBV-infected newborns develop chronic infection; up to 25% of these children will die of cirrhosis, liver failure, or liver cancer later in life.

A key to achieving that goal is ensuring that all pregnant women are tested for hepatitis B so that appropriate interventions can be taken upon the birth of the infant to a mother who tests positive for chronic hepatitis B infection--specifically, the provision of post-exposure prophylaxis (i.e., hepatitis B immune globulin and hepatitis B vaccine) to all infants born to HBV-infected women.

Fortunately, according to a 2014 CDC analysis, over 96% of all pregnant women in the U.S. are tested for hepatitis B infection as a standard part of their prenatal care. So a high percentage of mothers who could potentially transmit the virus to their newborns are detected. An estimated 70 percent of women chronically infected with hepatitis B were born in Asia, the Pacific Islands, or Africa, regions with the highest prevalence of hepatitis B infection worldwide. Access to this important screening may now be enhanced since it is among the Preventive Services that health plans are required to cover without charging a co-pay under the Affordable Care Act.

But that screening test is only the first step in preventing perinatal transmission of hepatitis B. Mothers who test positive need to be provided with case management services to ensure that they and their newborns receive the proper monitoring and services to prevent transmission. These services are available in all states through the CDC-supported Perinatal Hepatitis B Prevention Program. However, these programs only see fewer than half of the expected number of births to mothers who are infected with HBV. Given this gap in identification of births despite high rates of maternal testing, if we are to achieve the goal of eliminating transmission of hepatitis B from mother to child in the U.S., it is vital that we sharpen the focus of our efforts on expectant mothers who test positive for HBV.

Healthcare providers are critical to this effort. So, during this week that we celebrate both Mother’s Day and National Women’s Health Week as well as May’s observance of Hepatitis Awareness Month, it seems timely to call on all stakeholders with an interest in achieving this national goal of eliminating perinatal hepatitis B transmission to raise awareness among healthcare providers and others who provide services to pregnant women about important steps they can take to help us realize this life-saving national goal:

• Ensure all expectant mothers receive hepatitis B screening,
• Refer women who screen positive for chronic hepatitis B to:
  • The CDC-supported Perinatal Hepatitis B Prevention Program in the state health department for infant case management services and
  • A liver or infectious disease specialist to ensure appropriate management and consideration for treatment.

By sharpening our focus on these actions that can prevent perinatal hepatitis B transmission, we can improve the overall quality of health care for women with chronic hepatitis B and move closer toward the goal of eliminating perinatal hepatitis B transmission in the United States.